The primary mission of the NHLBI Cardiothoracic Surgical Network is to build an infrastructure for successful clinical trials in cardiac surgery. Te trials are designed and implemented in order to evaluate surgical interventions for the treatment of cardiovascular disease in adults. For the past five years Penn has been one of the eight core sites for the Network. Penn has been integral in both the design of these trials and their implementation and completion. We have been an active participant in both the severe and moderate ischemic MR trials, as well as the randomized trial of concomitant A-fib, and surgical infections registry. For this renewal, we plan to build on our experience learned over our first fie years as an integral member of the Network. This experience will allow us to be even more successful in enrollment and recruitment. We plan to partner, even to a greater extent, with Penn cardiologists, neurologists, anesthesiologists, as well as outside referral cardiologists in al aspects of every trial. New innovative strategies will be utilized to improve enrollment will include, but not be limited to, participation in the Aware For All Philadelphia community outreach event to raise awareness of the importance of clinical research and develop a video featuring all CTSN clinical trials to be shown on the state of the art 8'X30'X180' high resolution video wall located prominently in the Translational Research Center of the University of Pennsylvania. In addition, there will be emphasis by our cardiovascular clinical liaison and nurses on the NHLBI/CTSN clinical trials, monthly updates at both the cardiology and cardiac surgery faculty meetings on the state of the trials. We are also recruiting a new chief of cardiac surgery at Pennsylvania Hospital and a new 16 member cardiology group where they will focus on clinical research and the NHLBI trials. The Dean of the University of Pennsylvania Medical School, the Vice Dean of Research, the Chairmen of the Department of Surgery and Medicine, the Division Chiefs of Cardiac Surgery and Cardiology at the University of Pennsylvania have all committed to the primacy of the Cardiac Surgical Network trials over other competing trials.